S2504 Infiltrative Desmoid Fibromatosis of the Pancreatic Tail Diagnosed by Endoscopic Ultrasound-Guided Fine-Needle Aspiration

Transesophageal Endoscopic Ultrasound-Guided Mediastinal Lymph Node Aspiration: Does the End Justify the Means?

Another caveat for endoscopic ultrasound–guided fine needle aspiration

Best Practices in Endoscopic Ultrasound–Guided Fine-Needle Aspiration

Invited commentary

Objective: This study aimed to assess the diagnostic adequacy and accuracy of endoscopic ultrasound-guided fine-needle biopsy and fine-needle aspiration procedures. Methods: The data of patients who underwent combined endoscopic ultrasound-guided fine-needle aspiration and endoscopic ultrasound-guided fine-needle biopsy between July 2018 and January 2022 due to mediastinal or abdominal solid mass were retrospectively analyzed. The primary endpoint for diagnostic accuracy was the malignant or benign outcome and classification according to the Bethesda nomenclature system. Results: A total of 42 patients who underwent fine-needle aspiration and fine-needle biopsy in the same session were enrolled. It was found that the samples were taken diagnostically sufficient in 95% (40/42) of the patients with endoscopic ultrasound-guided fine-needle aspiration, and 64.3% (27/42) of that yielded the correct diagnosis. Diagnostic adequacy was observed in 71.4% (30/42) of the patients with endoscopic ultrasound-guided fine-needle biopsy, and diagnostic accuracy was found to be 52.4% (22/42). A statistically significant difference was observed between 3 pass endoscopic ultrasound-guided fine-needle aspiration and 1 pass endoscopic ultrasound-guided fine-needle biopsy regarding diagnostic adequacy (P = .003); no significant difference was observed between the 2 procedures regarding diagnostic accuracy (P = .268). The diagnostic adequacy and accuracy rates between endoscopic ultrasound-guided fine-needle aspiration and endoscopic ultrasound-guided fine-needle biopsy for each pass were statistically similar, P = .617 and P = .230, respectively. For lymphadenopathy or solid pancreatic masses, the diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration and endoscopic ultrasound-guided fine-needle biopsy was statistically similar, P = .219 and P = 1.00, respectively. In lesions smaller than 30 mm and larger than 30 mm, the diagnostic accuracy of endoscopic ultrasoundguided fine-needle aspiration and endoscopic ultrasound-guided fine-needle biopsy, respectively, was found to be statistically similar (P = .063, P = 1). Conclusion: Our center's overall diagnostic results for media stina l-abd omina l lymphadenopathy and pancreatic solid mass lesions were comparable and safe for fine-needle aspiration and fine-needle biopsy procedures. Cite this article as: Gök Sargın Z, Açıkgöz G, Üstündağ Y. Endoscopic ultrasound-guided tissue acquisition of media stina l-abd omina l lymph nodes and pancreatic mass lesions: A comparative study of fine-needle aspiration and fine-needle biopsy. Diagn Interv Endosc. 2022;1(2):44-47.

Endoscopic Ultrasound-Guided Fine Needle Biopsy without Rapid On-Site Cytologic Examination: A Time to Change the Paradigm?

INTRODUCTION: Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) is the standard method to obtain tissue sample for diagnosis of solid pancreatic masses but has variable accuracy. Endoscopic ultrasound guided fine needle biopsy (EUS-FNB) is a new technique that has been shown to have higher diagnostic yield compared to EUS-FNA. In October 2016, one of the authors (MS) began performing a combination of both FNA and FNB for solid pancreatic masses using a single 22 g Shark-core needle for possible higher diagnostic yield. Our study aims were to compare the diagnostic yield of combined EUS-FNA plus FNA versus EUS-FNA alone in solid pancreatic lesions. METHODS: We performed a retrospective chart review on all patients who underwent endoscopic ultrasound (EUS) by a single operator (MS) at Cleveland Clinic between 2015–2018. We included all adult patients who underwent either EUS-FNA or EUS-FNA + FNB for solid pancreatic or peripancreatic masses for the first time. Our primary outcome was to compare the diagnostic yield between the two groups (EUS-FNA versus EUS-FNA + FNB). EUS-FNA was performed using a 22-gauge needle (Boston Scientific) and EUS-FNA + FNB was performed using a 22-gauge Shark-core needle (Medtronic). Diagnostic yield was defined as the proportion of patients in whom a definitive tissue diagnosis was established from EUS sampling. The diagnostic accuracy was defined as the proportion of true positive and true negative EUS sampling results. P < 0.05 was considered significant. RESULTS: A total of 544 patients underwent EUS during the study period, of which 78 patients met the inclusion criteria. Of these 78 patients, 44 patients underwent EUS-FNA and 34 patients underwent EUS-FNA + FNB. EUS-FNA + FNB had a statistically significant higher diagnostic yield compared to EUS-FNA (97.1% vs. 72.7%; P = 0.02). EUS-FNA + FNB also had a higher diagnostic accuracy than EUS-FNA, but this was not statistically significant (P = 0.13). The number of needles passes were lower in the combined FNA + FNB group compared to FNA group (4 vs 5, P = 0.005). There was no significant difference in procedure duration between the two groups. CONCLUSION: Our study showed that combined EUS-FNA + FNB had higher diagnostic yield and required lower number of needle passes compared to EUS-FNA alone for solid pancreatic masses. EUS-FNA + FNB also had higher diagnostic accuracy; although this was not statistically significant. Based on our study findings, we suggest considering the combination of EUS-FNA + FNB for solid pancreatic lesions.

Know when to biopsy ‘em, know when to walk away

Endoscopic ultrasonography

EUS-guided FNA for diagnosing autoimmune pancreatitis: Doesit enhance existing consensus criteria?

4466 Effectiveness of eus/fna for diagnosing lung cancer in a managed care setting.

Mediastinal staging is of vital importance in the treatment planning of patients with nonsmall cell lung cancer who do not have distant metastases. Nodal assessment is often a challenge, however, and the limitations of staging methods are well recognized. Noninvasive studies can yield a presumptive clinical stage, but invasive tests are often necessary to determine the status of nodes in the absence of extensive mediastinal infiltration. Endoscopic ultrasound-guided fine needle aspiration and endobronchial ultrasound-guided fine needle aspiration are minimally invasive additions to the staging armamentarium that facilitate nodal biopsy under direct visualization without full anesthesia. In some cases, these procedures offer the opportunity for a patient to receive both a tissue diagnosis and staging in one sitting. While their roles are debated and evolving, their availability is increasing and they are reducing the need for surgical staging. Radiologists contribute to the evaluation of patients who may benefit from these up-and-coming procedures and should become familiar with endoscopic ultrasound-guided fine needle aspiration and endobronchial ultrasound-guided fine needle aspiration.

Objective. Few studies have assessed the diagnostic efficacy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and/or trucut biopsy (TCB) in patients with rectal and perirectal lesions. We aimed to evaluate the diagnostic utility of EUS-FNA and/or TCB in patients with rectal and perirectal lesions. We also assessed their influence on the management and clinical course of these patients. Material and methods. We performed EUS-FNA and/or TCB in 11 consecutive patients (4 men and 7 women, 33–69 years) with rectal and perirectal lesions for whom conventional diagnostic tools could not provide definitive diagnoses. Patients with definite intraluminal cancer were excluded. Results. The 11 patients underwent 12 procedures, with 9 being EUS-FNA alone and 3 being EUS-FNA and TCB. Seven patients had rectal lesions and four had perirectal lesions. Initial EUS-FNA and/or TCB established a diagnosis of malignancy in five patients and of benign lesions in four. EUS-FNA plus TCB confirmed malignant lymphoma after diagnostic failure of initial EUS-FNA in one patient. In one other patient with suspicious secondary linitis plastica, EUS-FNA could not establish a definitive diagnosis. Correct diagnoses were obtained in 10 out of 11 patients who underwent EUS-FNA and/or TCB. EUS-FNA and/or TCB changed clinical courses, which included avoidance of unnecessary surgeries, having a chance of anal sphincter-saving surgeries, and timely administration of chemotherapy. No serious complications related to the use of EUS-FNA or TCB were evident. Conclusion. EUS-FNA and/or TCB are useful in the diagnostic evaluation of and appropriate therapeutic plan in patients with rectal and perirectal lesions.

Optimizing endoscopic ultrasound guided fine needle aspiration through artificial intelligence.

Goals Our aim was to compare the diagnostic yield of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) versus combined fine needle aspiration and fine needle biopsy (EUS-FNA + FNB) in the evaluation of solid pancreatic masses (SPMs). Background EUS-FNA and EUS-FNB are established methods to diagnose SPMs. No studies have evaluated the efficacy of combination of both (EUS-FNA + FNB). Our senior author (MRS) hypothesized that combining the two techniques by using a single FNB needle improves diagnostic yield and started combination technique in October 2016. Study Patients who underwent EUS for SPMs by MRS during January 2014–September 2019 were included. They were divided into the EUS-FNA group and EUS-FNA + FNB group. EUS-FNA was performed using a 22 or 25 gauge Expect Slimline needle (Boston Scientific, Marlborough, MA) and EUS-FNA + FNB was performed using a single 22 or 25 gauge Shark-core needle (Medtronics, Minneapolis, MN, USA). Our primary outcome was to compare the diagnostic yield in the two groups. Results Among 105 patients included, 58 were in the EUS-FNA group and 47 were in the EUS-FNA + FNB group. EUS-FNA + FNB group had significantly higher diagnostic yield and required fewer needle passes compared to EUS-FNA group, 95.7% vs. 77.6%, p = .01: and 4 vs. 5, p = .002; respectively. Procedural duration was similar in both groups but the combined technique required less number of needles per procedure. There was no difference in adverse events in the two groups. Conclusion Our study showed that combined EUS-FNA + FNB had higher diagnostic yield compared to EUS-FNA in SPMs along with less number of needle passes and needles required. Further prospective studies are needed to validate these findings and cost-effectiveness of this strategy.